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Physical growth and social prognosis of esophageal atresia after 15 years of age 査読あり
Masuya R., Muto M., Sugita K., Murakami M., Yano K., Harumatsu T., Onishi S., Yamada K., Yamada W., Matsukubo M., Kawano T., Machigashira S., Nakame K., Torikai M., Mukai M., Kaji T., Ieiri S.
Annals of Pediatric Surgery 18 ( 1 ) 2022年12月
担当区分：筆頭著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Annals of Pediatric Surgery
Background: The mortality rate of esophageal atresia (EA) has significantly improved, but late complications remain problematic. We evaluated the physical growth, late complications, and social prognosis of postoperative patients with EA who have reached 15 years of age. Methods: EA patients who were treated at our institution from 1984 to 2003 were enrolled. The follow-up, physical growth at the last visit, late complications and treatment, academic status, and employment situation were evaluated. Results: Twenty-nine EA patients were registered, and the 23 surviving patients (79.3%) were followed. Anthropometry at the latest visit tended to be below the standard values. Fundoplication was performed in 6 (26.1%) of 9 (39.1%) patients with gastroesophageal reflux. Anastomotic stenosis was found in 12 patients (52.2%), and 2 (8.7%) were treated with re-anastomosis. Thirteen patients were attending a regular school, and one was attending a school for disabled children. Four had jobs from 18 years of age. Follow-up was aborted during early childhood in nine patients. Conclusions: The physical size of EA was smaller than in the healthy population of the same age. Late complications had not affected the physical growth but were sometimes recognized in adolescence. The social prognosis of the patients was largely favorable.
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Circulating maternal chimeric cells have an impact on the outcome of biliary atresia 査読あり
Masuya R., Muraji T., Kanaan S.B., Harumatsu T., Muto M., Toma M., Yanai T., Stevens A.M., Nelson J.L., Nakame K., Nanashima A., Ieiri S.
Frontiers in Pediatrics 10 1007927 2022年9月
担当区分：筆頭著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Frontiers in Pediatrics
Introduction: We aimed to quantify the DNA of maternal chimeric (MC) cells in the peripheral blood of the BA patients and investigated the impact on the outcome. Methods: Patients with progressive jaundice because of no bile flow, which necessitated liver transplantation, or who showed inadequate bile flow with or without episodes of cholangitis and progressive hepatic fibrosis and portal hypertension were classified into the poor group. Those with adequate bile flow with completely normal liver function tests beyond 2 years were classified into the good group. The qPCR were separately carried out in buffy coat samples and plasma samples, targeting the non-inherited maternal HLA alleles in the DNA samples. Results: MC-DNA was present in the buffy coat (10–328 gEq per 106 host cells) in seven patients. There was no MC-DNA in the remaining five patients. MC-DNA (214–15,331 gEq per 106 host cells) was observed in the plasma of five patients. The quantity of MC-DNA in the buffy coat showed a significant difference between the two prognostic groups (p = 0.018), whereas there was no significant difference in the quantity of MC-DNA in plasma (p = 0.205). MC-DNA in the buffy coat was significantly associated with the outcome (p = 0.028), whereas MC-DNA in the plasma did not influence the outcome (p = 0.56). Conclusions: Poor outcomes in BA were correlated with circulating maternal chimeric lymphocytes.
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Masuya R, Nakame K, Tahira K, Kai K, Hamada T, Yano K, Imamura N, Hiyoshi M, Nanashima A, Ieiri S
Asian journal of endoscopic surgery 15 ( 3 ) 693 - 696 2022年7月
担当区分：筆頭著者 記述言語：英語 掲載種別：症例報告 出版者・発行元：Asian journal of endoscopic surgery
INTRODUCTION: In recent years, dome resection, which preserves the splenic immunological function, has been the primary technique used to treat splenic cysts. We herein report a surgical technique using a needle grasper and indocyanine green (ICG) fluorescence to perform dome resection of a huge nonparasitic splenic cyst in a pediatric patient. PATIENT AND SURGICAL TECHNIQUE: A 13-year-old girl was incidentally diagnosed with a splenic cyst during follow-up for scoliosis. Abdominal enhanced computed tomography (CT) showed a 17 × 14 × 14 cm unifocal cyst. Laparoscopic dome resection was planned. The intraoperative findings showed that the spleen was distended, but there was no apparent prominence of the thin cyst wall on the surface of the spleen. An ICG fluorescence camera overlay revealed poor coloration in the thinning area. We punctured the area and aspirated the cyst contents. We grasped the cyst wall with a percutaneous needle grasper and dissected the cyst wall with a vessel sealing system. We placed anti-adhesion agent at the dissection line to prevent recurrence. DISCUSSION: ICG fluorescence was useful for identifying the thinning area of a splenic cyst. The use of a percutaneous needle grasper facilitated the performance of dome resection of a huge splenic cyst in a pediatric patient with minimal invasiveness and an improved cosmetic outcome.
DOI： 10.1111/ases.13052
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Masuya R., Matsukubo M., Nakame K., Kai K., Hamada T., Yano K., Imamura N., Hiyoshi M., Nanashima A., Ieiri S.
Surgery Today 52 ( 10 ) 1510 - 1513 2022年5月
担当区分：筆頭著者 記述言語：英語 掲載種別：症例報告 出版者・発行元：Surgery Today
We describe a laparoscopic surgical technique using indocyanine green (ICG) fluorescence to identify and preserve rare arterial branching associated with pediatric congenital biliary dilatation. Congenital biliary dilatation with pancreaticobiliary maljunction was diagnosed in a 9-year-old girl, who presented with upper abdominal pain. Abdominal enhanced computed tomography (CT) showed that the accessory right hepatic artery (aRHA) branched from the posterior superior pancreaticoduodenal artery (PSPDA) and flowed through the right aspect of the dilated common bile duct (CBD) directly into the right lobe of the liver. We performed laparoscopic dilated biliary duct resection and hepaticojejunostomy, administering ICG intravenously, at a dose of 0.6 mg/kg. The ICG fluorescence overlay mode showed an aRHA running along the right side of the dilated CBD. The aRHA was dissected from the CBD without injury. After finishing the anastomosis, the beating of the aRHA was preserved, confirming that blood flow had been maintained.
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Masuya R., Muto M., Nakame K., Murakami M., Sugita K., Yano K., Onishi S., Harumatsu T., Yamada K., Yamada W., Matsukubo M., Kaji T., Nanashima A., Ieiri S.
Journal of Laparoendoscopic and Advanced Surgical Techniques 32 ( 5 ) 571 - 575 2022年5月
担当区分：筆頭著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Laparoendoscopic and Advanced Surgical Techniques
Background and Aim: The distribution of board-certified pediatric surgeons (BCPSs) in Japan is highly biased. While Prefecture M has one of the smallest numbers of BCPSs per pediatric population, neighboring Prefecture K has one of the largest numbers of BCPSs per pediatric population. We examined the effect of BCPSs population on laparoscopic surgery and postoperative management and outcomes. Materials and Methods: We compared postoperative duration to full-dose enteral nutrition, postoperative hospital stay, and complications of neurologically impaired patients who underwent laparoscopic fundoplication in two prefectures from 2006 to 2019. Results: Laparoscopic fundoplication was performed in 17 patients in Prefecture M and 63 in K. The mean operative time was 248.8 ± 79.9 minutes in Prefecture M and 260.8 ± 94.8 in K (P = .64). The median number of days to full-dose enteral nutrition was 11.5 in Prefecture M and 10 in K (P = .29). The median postoperative hospital stay was 14 days in Prefecture M and 15 days in K (P = .38). Postoperative complications occurred in 7 cases in Prefecture M and in 10 in K. The incidence was significantly higher in Prefecture M than in K (P = .041). Conclusion: Areas with insufficient numbers of BCPSs have a higher risk of complications in laparoscopic surgery than areas with sufficient numbers.